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�J boj Jdl vib Urive • Iviull J.al I I IIII, l../y J luJ r • k4uu) J I u Jvuu I ,.Jl k Fuul v_ 'ill <br /> U 819 Striker Ave , Suite 8 • Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> ❑404 N Wiget Lane•Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> Bosco U 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865' FAX (707) 792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Protect Name ��� <br /> Address �,1�� � � ,G � ��-T TOSCO Engineer (required) <br /> City J ,� State Zip Code q � <br /> Telephone 92,5, ��� �f � FAX # �. 5V ,7�� Site #, City, State � � _� <br /> U <br /> Report To S YDS(.� Sampler �� DC Data Level D (Standard) Ll Level C LlLevel B U Level A , <br /> Analyses Requested <br /> Turnaround Wark Days ❑5 Work Days EJ3 Work Days ❑ Drinking Water <br /> Time U 2 Work Days ❑ 1 Work Day U 2-8 Hours U{Haste Water \0 <br /> 0\�5 \P%V AQP <br /> CODE: l] Mise U Detect ❑ Eval U Remed U Demol U Closure U OtherCont Sequoia's moa \05 `goo <br /> Client <br /> 1 D Sampled Matrix <br /> Cant Type Sample # eP \ ��QP�Q`Z'`P `o �Voc Comments <br /> Sample <br /> o r A <br /> DaleI <br /> a <br /> 2 FIU� 02-A <br /> esc <br /> 3 0 211111n o 0 <br /> 4 <br /> 5 . <br /> 6 .h 3 /va <br /> 7 V <br /> 8 V <br /> g � o <br /> cr <br /> 14 °' <br /> Relinquished By Date Ime /��r4 Received By Dater rJr Time d r <br /> Relinquished By <br /> t' Date / /� Time/0r— R elv� v = Date /� / Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes U No Samples on Ices U Yes ❑No Method of Shipment Page _of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)ViA1111111111111khe report issued within the requested turnaround time? ❑It No if no, what was the turnaround time? <br /> Com an <br /> Approved y - _ Signature _ p Y <br />